Does Tumour Contrast Retention on CT Immediately Post Chemoembolization Predict Tumour Metabolic Response on FDG-PET in Patients with Hepatic Metastases from Colorectal Cancer?

PURPOSE: The exact mechanism of action of chemoembolization with drug eluting beads loaded with irinotecan (DEBIRI) in colorectal cancer is undetermined. Posttreatment tumour contrast retention often seen on CT immediately post procedure is of indeterminate significance. This study is aimed at assessing if metabolic response on PET-CT can be related to posttreatment tumour contrast retention. MATERIALS AND METHODS: In this retrospective study, a total of 17 patients with a total of 55 marker lesions were recruited. RESULTS: The area of tumour contrast retention can be matched to a hypometabolic area on subsequent PET-CT in over 36 lesions (65.5%). Out of the 55 lesions, a total of 38 marker lesions in 11 patients who also had pre-DEBIRI PET-CT were analyzed for disease response. 10 out of 10 lesions that had a complete response on PET-CT were found to demonstrate contrast retention throughout the tumour. 12 out of 13 (92.3%) tumours that had a partial metabolic response on PET-CT were found to demonstrate contrast uptake in the hypometabolic area only. In the 15 lesions that had progression/no response, 13 (86.6%) demonstrated no relationship between tumour contrast retention and tumour response. There was a significant correlation between contrast retention and disease response (P < 0.001). CONCLUSION: Our study showed that PET-CT response can be associated with post embolization contrast retention. The data suggests blood stasis, for which tumour contrast retention is a surrogate marker, is important for the PET-CT metabolic response. The authors propose that tumour contrast retention is an important embolization endpoint in DEBIRI.

Effect of age on the relationship between gastric cancer and Helicobacter pylori. Tokyo Research Group of Prevention for Gastric Cancer.

Helicobacter pylori is thought to be involved in the pathogenesis of gastric cancer, but the time point at which it produces its effects (critical time) is unknown. We measured the serum level of H. pylori antibody in 787 gastric cancer patients and 1007 controls aged 20 to 69. Odds ratios for different gastric cancer types and stages were determined for each 10-year age class. The overall odds ratio for gastric cancer decreased with age, being 7.0 for those aged 20 - 29, 14.5 for those aged 30 - 39, 9.1 for those aged 40 - 49, 3.5 for those aged 50 - 59, and 1.5 for those aged 60 - 69 (trend in odds ratios: P < 0.01). However, there was no such age-dependent trend for early diffuse-type cancer; the odds ratios were 12.6, 4.0, 7.2, 6.5, and 18.5 respectively (P = 0.29). Early cancer tended to show higher seroprevalence than advanced cancer, especially in older subjects. No significant difference in seroprevalence was observed between diffuse and intestinal cancers within each age-class. Seroreversion must have occurred in the time interval between the critical time and the diagnosis of the cancer, especially in older patients. The age-dependent relationship between H. pylori and gastric cancer may be due to seroreversion, which itself may be independent of age. This age-independence indicates that prolonged exposure to H. pylori does not increase the magnitude of its influence on gastric carcinogenesis. Possible mechanisms through which H. pylori exerts pathogenic effects are continuous inflammation in adulthood and / or irreversible damage to gastric mucosa in childhood or the teenage years.

[Is Palmaz-Schatz stenting effective for second restenosis?].

The long-term outcome after coronary stent placement in restenotic lesions after balloon angioplasty (percutaneous transluminal coronary angioplasty: PTCA)may be less favorable compared to stent treatment of de novo lesions, but the role of stents in restenotic lesions after 2 prior PTCA procedures is unknown. Elective Palmaz-Schatz stent placement was performed in 124 consecutive patients. Stents were placed in 70 patients(56%) in the native coronary arteries for de novo lesions(de novo group), in 33 patients (27%)for restenotic lesions after one prior PTCA(restenosis group), and 21 patients(17%)for restenotic lesions after 2 prior PTCA(second restenosis group). The 3 groups were well matched with respect to lesion type, lesion length, and reference diameter. Stent size was similar in the 3 groups. Follow-up angiograms taken about 6 months after stenting were available for all patients. The restenosis rate after stenting was similar for the de novo group and restenosis group(19% vs 27%, NS). The second restenosis group tended to have a higher restenosis rate after stenting than the de novo group(38% vs 19%, p = 0.06). The frequency of diffuse type in-stent restenosis of the second restenosis group tended to be higher than that of the de novo group(63% vs 13%, p = 0.08). Our results suggest that the restenosis rate after stenting was higher in patients with repeated restenosis. Therefore, other therapeutic methods should be considered.

[Percutaneous transluminal coronary angioplasty for restenosis following Palmaz-Schatz stenting: larger size balloons are more effective?].

Intracoronary stenting reduces the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA). However, restenosis still occurs in 20% to 30% of patients after stenting. Management of in-stent restenosis has become a significant challenge in interventional cardiology. The efficacy of re-PTCA with a larger balloon was investigated for restenosis following Palmaz-Schatz stenting. Clinical and angiographic results were compared in 46 consecutive patients with in-stent restenosis after one Palmaz-Schatz stenting. Twenty patients underwent redilation with a slightly larger balloon than used at the stenting (Large group) and 26 underwent redilation with the same size balloon as at the stenting (Control group). The clinical factors, lesion characteristics, lesion length, reference diameter and minimal luminal diameter at re-PTCA for the in-stent restenosis did not differ significantly between the 2 groups. Minimal luminal diameter of the Large group after re-PTCA was significantly larger than that of the Control group (3.1 +/- 0.2 vs 2.9 +/- 1.2 mm, p < 0.05). Follow-up angiography showed that the minimal luminal diameter of the Large group was significantly larger (2.1 +/- 0.6 vs 1.7 +/- 0.6 mm, p < 0.05) and the re-restenosis rate of Large group tended to be lower than that of the Control group (15% vs 38%, p = 0.07). Re-PTCA for in-stent restenosis with a slightly larger balloon than used at the stenting reduces the re-restenosis rate.

[Wrapping operation for Stanford type A acute dissecting aneurysms].

Four cases of Stanford type A acute aortic dissection were treated by wrapping operation. After careful dissection between the dilated ascending aorta and right pulmonary artery, 8 mm woven Dacron vascular prosthesis was passed around the aorta and tightened. Further enforcement wrapping was carried out using several prostheses from aortic root to the innominate artery. We call this technique "wrapping operation". Emergent operations were performed on all patients because of cardiac tamponade, 6.8-33 hours after the onset of dissection. Three patients are doing well 17-39 months after the operation, but only 1 patient died early postoperative period because of DIC and multiple organ failure. And 2 patients was showed closure of entry of the ascending aorta by the postoperative aortography. We think that the wrapping operation is a useful technique for the patients of ruptured Stanford type A acute dissecting aneurysms.

[Primary coronary artery dissection: its incidence and genesis studied by clinical and coronary angiographic findings].

The incidence and genesis of primary coronary artery dissection which occurred spontaneously in the coronary artery system were elucidated in this study. We examined clinical and coronary angiographic features of the patients who presented this dissection. Primary coronary artery dissection was observed in 23 (0.43%) of 5,400 consecutive patients with ischemic heart disease undergoing coronary angiography. The basic diseases were myocardial infarction in 17 cases and angina pectoris in 6. Sixteen patients (70%) had smoking habits, which might be related to this disease. The dissection of the right coronary artery in 12 cases, of the left anterior descending artery in 10, and of the left circumflex artery in only one was found. All lesions occurred in the proximal positions of the coronary branches. Seven (30%) of all cases had fixed coronary stenosis in other coronary branches. The other cases had "one-vessel" disease. Seventeen patients were treated medically, 5 had PTCA therapy and one had CABG operation. All the patients, except one who died of cancer are surviving in a 3.8-year follow-up. Patients can be divided etiologically into three groups. The first was comprised of those in the post- or peri-partum period. The second was those associated with coronary vasospasm, and the third was those with atherosclerotic coronary artery disease. The third group was the most frequent.

[Coronary artery disease in patients with abdominal aortic aneurysm].

Selective coronary angiography to determine the prevalence of coronary artery disease (CAD) has been performed in patients with abdominal aortic aneurysm (AAA). Thirty patients in this series consisted of 26 men and 4 women with an age range of 48-87 years (mean +/- SD: 67.5 +/- 8.2 years). As the atherosclerotic risk factors, cigarette smoking was present in 19 patients (63.3%), hypertension was in 18 (60%), hypercholesteremia was in 10 (33.3%), and diabetes mellitus was in 2 (6.7%). Cerebral vascular disease was present in 11 patients (36.7%). Regarding CAD, angina pectoris or old myocardial infarction was found in 9 patients (30%), and abnormal electrocardiography (ECG) was in 16 patients (53.3%). Coronary angiography prior to operation of AAA was performed to 22 patients (73.3%), and 15 patients (68.2%) among them had significant coronary artery stenosis, and 9 patients underwent myocardial revascularization (4 CABG, 5 PTCA). CAD was frequently complicated both in patients without symptoms or ECG abnormalities and in less than 65-year patients. In order to prevent fatal myocardial infarction, we recommend routine coronary angiography to patients with AAA. And if necessary, myocardial revascularization must be indicated prior to aneurysmectomy.

Alkaline phosphatase isoenzyme of colonic carcinoma in Wistar-Furth rats.

Wistar-Furth (WF) strain rats have been shown to have a high incidence of spontaneous colon cancer. We have compared the alkaline phosphatase (AP) isoenzymes in colonic carcinomas of these inbred WF strain rats with the isoenzymes in the non-carcinomatous colon of the same strain and the normal colon of Wistar strain rats, from which the WF strain was derived. On electrophoresis of AP specimens partially purified by acetone fractionation, the non-carcinomatous colon was found to have three main isoenzymes, while the normal colon had two. Colonic carcinomas gave one band which migrated slower than any bands from either normal or non-carcinomatous colon. The electrophoretic mobility of AP from colonic carcinomas was retarded by neuraminidase treatment. This did not influence the isoenzymes from non-carcinomatous and normal colon. The inhibition patterns of the enzyme from colonic carcinoma by amino acids, inorganic phosphate and urea were different from those of the isoenzymes in the other two tissues. AP of colonic carcinoma was also the most heat-labile. There were no significant differences in the enzymic properties of the isoenzymes from non-carcinomatous and normal colon. The enzymic properties except for electrophoretic mobility were found to be the same between APs of colonic carcinoma and the placenta.

Proatlantal intersegmental artery with absence of bilateral vertebral arteries. Case report.

A case of proatlantal intersegmental artery with absence of bilateral vertebral arteries is presented. This rare anomaly was accidentally encountered on angiography in a patient with a ruptured aneurysm of the anterior communicating artery.

A novel alkaline phosphatase, a minor component of normal liver phosphatases.

A novel alkaline phosphatase differing from the so-called liver-specific isoenzyme was found in four out of twenty-four normal adult livers. Although the mobility of this enzyme was the same as that of so-called liver-specific alkaline phosphatase on the polyacrylamide gel electrophoretogram, its mobility was not altered following neuraminidase treatment, while that of the liver-specific enzyme was affected by the same treatment. Both enzymes also differed in other enzymatic and immunologic properties. The enzyme, however, resembled the so-called intestinal alkaline phosphatase in many enzymatic and immunologic properties. Thus, the inhibition patterns by amino acids, EDTA and inorganic phosphate, the pH optima, KM values for phenyl phosphate and reactivity with anti-intestinal alkaline phosphatase antibody were quite similar for both enzymes. Differences in the properties of this enzyme and intestinal alkaline phosphatase were in sensitivity to denaturation by treatment with heat and urea and to inhibition by Levamisole. The possible origin of the enzyme in normal liver and its relationship to the Kasahara isoenzyme and fetal intestine-type in hepatoma is discussed.

A fetal intestinal-type alkaline phosphatase in hepatocellular carcinoma tissue.

We examined 19 hepatoma tissues for alkaline phosphatase isoenzyme and found that six have both the Kasahara isoenzyme and an alkaline phosphatase with a unique electrophoretic mobility, in addition to the liver-type enzyme. From two of six carcinoma tissues, the abnormal enzyme was partly purified and subjected to a detailed analysis, which clarified that the abnormal enzyme resembled a fetal intestinal alkaline phosphatase in most of its enzymic and immunologic properties and also in properties that reflect enzyme structure. This fetal intestinal-type alkaline phosphatase was not found in 24 specimens of normal liver from adults. The relevance of fetal intestinal-type alkaline phosphatase to Kasahara isoenzyme and adult intestinal alkaline phosphatase is discussed. The fetal and adult intestinal alkaline phosphatases differ in electrophoretic mobility, heat stability, and reactivity with concanavalin A. The adult-type enzyme has two components; only the electrophoretically slower, neuraminidase-resistant one is described here.

A hepatoma-associated alkaline phosphatase, the Kasahara isozyme, compared with one of the isozymes of FL amnion cells.

It was found that a human hepatoma-associated ALP (orthophosphoric monoester phosphohydrolase, E.C. 3.1.3.1) shared electrophoretic mobility, inactivation by urea, inhibition by inorganic phosphate, ethylenediaminetetraacetate, and amino acids (L-phenylalanine, L-leucine and L-homoarginine), heat stability, sensitivity to neuraminidase, pH optimum, Km value, and antigen site with fast moving ALP isozymes of FL cell strain derived from human amniotic membrane. However, 40-week-old fresh amniotic membrane lacked this isozyme. Instead, it had a placental type ALP consisting of minor components. The other ALP isozyme of FL cells had properties common to hepatoma ALP with regard to L-phenylalanine sensitivity, inhibition by ethylenediaminetetraacetate, inactivation by urea, and antigen site, but differed from it in electrophoretic mobility, sensitivity to L-leucine and L-homoarginine, and the presence of another antigen site. It was more heat stable and more sensitive to inhibition by inorganic phosphate than Hepatoma AP. The possible regulatory mechanism between the hepatoma-type ALP and the placental type ALP in the amnion cells is considered.